In addition to the motor signs of eyelid spasm, BEB patients also experience a distinct constellation of sensory symptoms. Most large series have reported that up to 79% of blepharospasm patients find bright light to be the most frequent exacerbating factor of blepharospasm. These patients also report bright light to still be highly bothersome in spite of muscle spasm relief. Many patients wear sunglasses even on cloudy days and experience extreme photophobia in normal or even low-light conditions. It has been postulated that the photophobia in blepharospasm represents a form of sympathetically maintained pain disorder, and some patients have experienced relief from superior cervical ganglion blocks.
Several studies within the past decade have demonstrated improvement in the symptoms of photophobia in BEB patients with photochromatic modulation, especially with the FL-41 lens tint, a rose-colored tint originally developed for patients with migraine headaches (Figure 1).[8,9] This particular lens tint not only increases the intensity of light that BEB patients can tolerate, but secondarily can also reduce their eyelid blink rate and further augment the control of the motor spasms associated with BEB. Photochromatic modulation with fluorescein placed in the fluid reservoir behind a scleral contact lens, between the lens and the cornea, has also been reported to result in significant improvement in photophobia symptoms for BEB patients. These advances in treatments clearly establish photophobia as a definite feature of BEB, and when appropriately addressed, can lead to meaningful improvement in patient symptoms and overall function.
The FL-41 lens tint, a rose-colored tint, has been shown to improve photophobia and reduce blink rate in patients with benign essential blepharospasm.
Curr Opin Ophthalmol. 2018;29(5):440-444. © 2018 Lippincott Williams & Wilkins